Dr. Venkata Lakshmi Narasimha MD DM
@narasimha_gvl
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MD PDF DM (Addiction Psychiatry) NIMHANS | UltraMarathon Runner | Clinician & Researcher | Assistant Professor, Centre for Addiction Medicine, NIMHANS Bengaluru
Bengaluru
Joined May 2010
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If you need a psychiatry consultation (for no cost)
call us, we will call you back-
AIIMS Deoghar
Telemedicine number +91 9973309349
Monday (only) 930 AM onwards-
Dr Santanu MD DNB
Dr Narasimha MD DM
Dr Manul MD
@vknNIMHANS_ECHO
@MoHFW_INDIA
@doc_santanu
4
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1/
Got a call at 330 (after OPD timings) that my old patient has come for follow up and wanted to see me.
Went to Opd and he was under influence of alcohol and crying
Patient: I relapsed for 10 days, I don’t want to drink, please help me, I am also fighting with my wife for🥃
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14
87
Prof. Chittaranjan Andrade a great teacher of research methodology from
#NIMHANS
I have a collection of his (simple) articles, which amounts to a stats textbook
A 🧵 (10/10) from my collection on must read articles
(Every resident doctor should know, RT for PGs)
6
23
80
10 years in
#psychiatry
(2013-23)
Three important learnings about suicide
1️⃣
#Alcohol
increases the risk of suicide both during intoxication & withdrawal
@theliverdr
2
18
72
#Ind
vs
#Eng
People 👀
Almost 50% of ads are surrogate marketing for
#Alcohol
&
#Tobacco
most of them promoted by
#super
stars
7 yr old son sitting next asking what is this ad for?
Who does the advocacy for change?
@theliverdr
@hyderabaddoctor
@askdheeraj
@atulambekar
4
12
47
4/
😞Have seen lot of people with traumatic experiences following harsh inhumane treatment at rehab centres run by unqualified people
❌Such experiences prevents treatment seeking
⏫Stigma towards addiction towards addiction treatment
@doc_santanu
@askdheeraj
@Dr_ArpitParmar
0
7
40
Going back now
4 patients: One hour per patient
Two meetings
Amazing lunch by mom in between
Grateful for the day
Finally....
Am home😁❤️🫂🫂🫂
Felt like such a looooooog day today...
Almost lost my balance but well..
Did decent...
23 +5 + 1 patient.
Few deep dives..
A really hard conversation
Uncomfortable but glad I'd braced...
Out of one more WhatsApp group on my own...
Peace...
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AIIMS Deoghar and AIIMS Rishikesh has psychiatry as independent paper in Final Year!
Personal perspective teaching MBBS students in psychiatry, training and early sensitisation helps
“Fear of being stigmatized by their own colleagues often turns out to be the reason for avoiding psychiatric consultation.” - Dr. OP Singh
How can we remove the stigma?
Can making Psychiatry an independent Final Year Subject help in increasing awareness?
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Story of our
#Addiction
Treatment Facility
For various reasons, it took us 2⃣ years to begin Opioid Substitution Treatment (OST)
(During that time, I saw only 1⃣ patient with heroin use)
OST (Buprenorphine) is an evidence-based treatment for people with
#Opioid
Dependence
1/4
3
5
31
Had a privilege to moderate a panel discussion on
#cultural
determinants of
#tobacco
use in
#Tribal
population
Expert panel
Prof. Surya Bali
@AIIMSBhopal
Dr. Dewesh
@Rimsranchi
Dr. Puneet Chahar
@TheUnion
Dr. Vinyagamoorthy
@deoghar_aiims
100 participants intensive 45 min
2
3
32
Conducted 2nd
#Evidence
based medicine workshop
@deoghar_aiims
for faculty
Privileged to be an speaker with
@meenusingh4
mam ED
@aiimsrishi
& her team
It is always exciting 2 teach syst. reviews & metanalysis with a wonderful group
🙏
@drsaurabh68
sir for opportunity
2
5
31
On 1st January 2021 started the
@DepartmentAiims
alone
Now we are a big team
@deoghar_aiims
@doc_santanu
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In the last 5 years
30min daily physical activity is part of > 90% of my prescriptions🚶♀️🚶
As I continued reading research, I realised the significance of spending an extra 2 min to stress my message.
What's new?
⏫ hrs of sedentary behaviour = ⏫ risk of
#dementia
1/2
2
5
28
Spoke at
#Addicon2023
Jaipur
#Tobacco
Industry Interference on
#Medical
Institutions
Clinicians & academicians need to stay away from the influence of
#TobaccoIndustry
🔸Research funding
🔸CSR activities
🔸Health Policy
🔸Many more...
Same applies to
#Alcohol
industry too!
1
1
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Are you posting your
#AlcoholParty
pics on
#SocialMedia
?
This is dangerous to you & your followers
Exposure to & self-posting of, alcohol-related content on social media is positively associated with
🔸Current average consumption
🔸Problem drinking
🔸Drinking frequency
1/4
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Many think that
#Harm
due to substances occurs only in addicted individuals🍀🍷
❌Not correct!
➡️Harms due to the use of substances can occur even with single/recreational/episodic use
🧵 from my recent experience
@doc_santanu
@DepartmentAiims
1
6
25
Family
@isamnext
Happy to connect with everyone virtually for the meet and greet program with ISAM
#travel
awardees at
@ISAMAddiction
annual conference
Congratulations 🙌!
@drroshansindia
@Dr_Preethy_K
@baldacchinoa1
@atulambekar
@drhalghafri
@KanabarMd
@Jiang_Long
#ISAM
1
6
24
3️⃣ Some of my patients died by suicide. Among them, most of them died when they “lost to follow up.”
- Retention to treatment plays an important role
@doc_santanu
1
4
23
#Alcohol
#Tobacco
and
#Infectious
diseases
Moderated a panel discussion
with a heterogenous group
1. Regional adviser WHO SEARO (tobacco) Dr Jagdish Kaur
2. Prof.
@atulambekar
addiction psychiatrist, policy expert
@nddtc_aiims
3. Prof. Pratima Gupta, Microbiologist
3
6
24
Are you a
#journalist
who reports about
#alcohol
:
Recently
#WHO
recommended 6 important points to be considered "when you report about
#alcohol
".
Quote tweet by tagging a journalist that you know as this 🧵has significance in the context of
#PublicHealth
@the_hindu
1/n
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6
22
‼️Finally, published📰
💕This is paper is personally so special for me
🚨 Gist of the paper in a line:
👩⚕️Doctors ask about substance use but do not intervene
🖇️
🧵on my effort behind the 📰
1⃣ my first thread; will learn 2 make better ones overtime🙂 1/8
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4
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3/
Me: You will be staying with your wife and you will staying at one of the best hospitals in the state
@deoghar_aiims
! Trust me
Patient: (Reluctantly accepted) ok sir
I went for rounds in the evening
Patient: Sir, this looks like a five star 🏨 hotel🙏 I will stay
1
3
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#EFICON
2023
#Goa
Honoured to be one of the speakers in a plenary session along with
@drsaurabh68
ED
@deoghar_aiims
We spoke about
#Tobacco
Industry Interference in
#Medical
institutions
Project is funded by The UNION
2
4
22
NIMHANS 5km run occasion of
#WorldMentalHealthDay
on 2nd october. In beautiful campus! It's free but registration mandatory! Need some promotion! Scan the QR code for registration
@prabhatVKN
@globalpmh
@ManjunathaAdc
@lekhanshshukla
@ASICS_India
@Nike
0
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22
#Centre
for
#Addiction
Medicine
@NIMHANS_BLR
Congratulations
@drsdarsh
#Gaurav
completing the DM Addiction Psychiatry
All the best!
3
2
22
Thank you so much 🎉🎉 Great News!
We
@isamnext
are honoured to have our paper selected
@ISAMAddiction
@drroshansindia
@baldacchinoa1
@MehdiFarokhnia
@jenna_butner
@SArunogiri
#BJPInternational
Editor’s Choice ‘Harm reduction and abstinence-based models for treatment of substance use disorders during the COVID-19 pandemic: a global perspective’
@narasimha1988
et al
Article:
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2️⃣ A patient reports of
#Suicidal
thoughts during
#OPD
visit consider seriously and monitor with supervision & support till they subside
- It is important to educate not only patients, but also caregivers
@askdheeraj
1
3
20
#Depression
during the perinatal period, specifically post-partum is associated with an increased risk of
#suicidal
behaviour
🔸3X ⏫ risk
🔸Highest during 1st year can remain ⏫ till 18 years
It is important to recognise and treat
@globalpmh
#OBGY
2
9
20
Long ago when I was doing my MD in Psychiatry during my CL posting
Referal from Orthopaedics
Reason for referral: Patient not willing for surgery kindly counsel the patient
🤦🏻♂️
On psychiatry consult-liaison (C/L), we see the complex interplay of SMI and medical illness.
Most frustrating part of C/L:
Getting consulted because “Pt is tearful”
No SI/HI, no prior SA or history of SMI.
Just—Pt has normal human emotions…
Stop disordering our humanity.
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1/8
An elderly man repeatedly peeping into the OPD for a consult of his son.
His file is after 5 patients, told it will take an hour.
👴My son is restless & I am old🙏
✅ I told my SR to see him nxt
➡️25 yr old & unkempt came in
🧐I thought he has schizophrenia
❌I’m wrong
1
4
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What was the MOMENT in 2023 that you will always remember?
For me, it was when I read the appreciation note from "Ms Nice", one of my patients, in the State-of-the-Art Lecture during EASL.
I wish you all a great 2024 !
#Happy2024
#Livertwitter
@EASLedu
@AEEHLiver
@AASLDtweets
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0
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Got a wonderful opportunity to have an interactive dinner followed by coffee ☕️ with Prof. Norman Sartorious, Former Director of
#WHO
Division of
#mentalhealth
@NormanSartorius
and Prof. Pratima Murthy Director
@NIMHANS_BLR
@pratimamurthy
0
0
19
Having discovered the joys of long-distance running 🏃♂️, I began to appreciate the beauty of nature 🌳 even more through long-distance cycling 🚴♂️ (65km)
#fitness
#outdoorlife
#nature
#cycling
#running
0
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Duration of untreated psychosis (DUP) &
#schizophrenia
This topic has been extensively examined
consistent finding:
🔸Longer DUP is associated with more severe adverse outcomes, including cognitive impairments
Patients, families explore many options before they reach a doctor
1
4
19
Although we are a small department (2 faculty
@doc_santanu
and I) from a budding AIIMS Deoghar, our advocacy is strong 💪
4 schools more than 500 students were sensitised.
12 faculty across 9 specialties,
19 MBBS & 4 nursing students were involved in the program execution.
2
3
18
#MOU
between
@deoghar_aiims
&
@NIRTH_Jabalpur
Happy to be part of the team working on
#Tribal
#Health
This will help reducing treatment gap among tribal populations by strengthening health systems, research capabilities and training Human Resources
0
1
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#50
km
#cycling
for the first time
What is the
#cycling
🚴♀️
#running
equivalence
@hyderabaddoctor
sir any consensus of this?
___ km of 🚴♂️ = ___ of running 🏃
3
1
18
NIMHANS among the worldwide best hospitals for psychiatry! Proud moment!
Extremely proud and pleased too see my alma mater listed among the top institutes for psychiatry speciality worldwide.
0
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1
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Thanks
@ISAMAddiction
for the fellowship award.
Thanks
@isam2019
for such a wonderful conference!
Thanks
@nddtc_aiims
team you are Amazing hosts.
Special thanks to enthusiastic aiims residents
@askdheeraj
@GayatriBhatia7
and team
@baldacchinoa1
@atulambekar
@drroshansindia
5
1
15
Had the privilege of moderating a session on
#Tobacco
use in
#Tribal
Communities
with panellists
Prof.
@drsaurabh68
@deoghar_aiims
Prof. Sonu Goel
@djicmhpgimer
Dr. Bijay
@AIIMSPatna
Dr. Amit Yadav, The UNION
Highlights:
1⃣ Prevalence is ⏫ than the general population
1/2
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2
17
What is the 🤦🏻♂️ referral you got till date?
Mine 👇
“Refer to psychiatry- patient not willing to take medication”
@doc_santanu
13
2
17
Today DGHS-GOI made changes to buprenorphine availibity to psychiatric clinics and hospitals in addition to designated deaddiction centres. Thanx to efforts of psychiatric association.
@atulambekar
@prabhatVKN
@ompsychiatrist
@netshrink
@DiptadhiM
@jayanishere
@abhiloquacious
1
3
13
What are the first-line therapies for the treatment of
#Alcohol
Use Disorders?
1. Naltrexone
2. Acamprosate
📜Latest SR & MA that included
🟡118 clinical trials & 20 976 participants
What are other therapies?
What helps people quit alcohol?
👇
1
6
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2/
Me: Let me admit you and help!
Patient: No sir give me a last chance I will try to stop alcohol at home
Me: It’s easy to stop alcohol as inpatient admission than at home. What are you worried about?
Patient: Last time I was beaten up in the rehab centre, I am afraid 😱
1
1
13
1/
Common question from my colleagues
@deoghar_aiims
How do we
@DepartmentAiims
treat people who visit us (or bought by family) for the treatment of
#addiction
?
A simple overview🧵
✅ We assess the severity of addiction & associated comorbidities
🧠Motivation to stop the drug
1
5
16
#First
patient
#Father
of my patient
@DepartmentAiims
met me in corridors & told his son is doing well for last 2.5 years. Now he got admission for graduation
I want to give you a gift 🎁 please accept
How do you handle ?
My response 👇(I don’t know if it’s right or wrong)
4
1
15
#ADDA
#AIIMSDeoghar
Digital Acadmey
#Happy
to see something that we started in Jan2023
@deoghar_aiims
taking its shape
We started 2
@ECHOIndiaTrust
program
🤰High risk
#pregnancy
🏥critical care
This will bridge knowledge gap in
#Tribal
Health Care Workers
@drsaurabh68
2
3
15
After camp I understood, Addiction services need to be closer to community, this will help more people to seek treatment! This will help to reduce the treatment gap!
@virtual_NIMHANS
has a great role in training health professionals at the grass-root level to reach more people!
0
1
12
#ISAM
NExT
It is a honour, privilege to be elected as Co-Chair of
@isamnext
with
@Jiang_Long
as chair 🙌
New & exciting responsibility!
Will work towards achieving goals & vision of
@ISAMAddiction
&
@isamnext
Thanks to everyone who supported in this journey 👇
1/2
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In my experience
Residents use to join Psychiatry at NIMHANS thinking -cool branch & no night duties
After a month, few of them use to leave seeing the work load & duties.
Changing careers requires more support
14416 telemanas can help
👉🏻 Answer applicable to all residents in such a situation.
I'm very concerned to hear about what you are going through. First and foremost, it's important to address your immediate safety and mental health. Reach out to a trusted individual, whether a friend, family member, or
2
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Prof. Andrade taught us as JR and SR
@CochraneLibrary
provided us training and guided us publish SR and MA
@NIHRresearch
We published a
@CochraneLibrary
protocol with Ongoing review
1
2
14
@hyderabaddoctor
Sir, would like to bring to your attention about the use of word diabetic, I thought this will be useful in your future tweets.
“People with diabetes”
Not
Diabetics
3
0
11
Impact of COVID-19 on people with alcohol dependence.
@lekhanshshukla
@jayanishere
@JayantMahadevan
@prabhatVKN
@pratimamurthy
@DiptadhiM
@uditpanda
@docsudhee
@ISAMAddiction
@ASAMorg
@atulambekar
@drrvrao
@sidhart90328541
@baldacchinoa1
@farhoudian
@abhiloquacious
@netshrink
Complicated Alcohol Withdrawal—An Unintended Consequence of COVID-19 Lockdown
0
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0
4
14
Will be talking about
#History
of
#psychedelics
tomorrow
#ANCIPS2024
#Kochi
Here is my presentation 👇
1
0
14
Hello, my colleague
#OBG
friends 👋
(RT Tagging a OBG friend)
Did you note the new screening guidelines from ACOG?
New recommendations:
🔸Minimally screen for depression at least twice in pregnancy (initial prenatal visit and later)
🔸Again, at postpartum visits
How?
1/5
1
5
15
For many who did residency at
#NIMHANS
@NIMHANS_BLR
Bun + Samosa (=samosa burger) 🍔
At Nagraj coffee shop has been breakfast, lunch sometimes dinner too
@CerebralWizard
@miryalasrikanth
@AbhiLenka11
Yesterday, I saw a poster for Samosa Burger in Cardiff.
What on earth is this?
I like the idea of fusion of food, but Samosa is a full meal in itself.
Who's doing this to Samosa? & Why?
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Are looking for help for your
#mentalhealth
?
☝️ useful source👇
@DepartmentAiims
of
@deoghar_aiims
provides
#telepsychiatry
services free on Monday
9973309349☎️
4 specialists team led by
@doc_santanu
On an ave provides 25 free consults across 🇮🇳
One of the best IMHO
2
4
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3/9
➡️ All patients should be explained to stop lithium for a brief while when there are loose stools
✅ Regular therapeutic drug monitoring is needed
⬇️Do not continue taking medications without prescription
➡️Educate patients about Li
@doc_santanu
& I do this regularly
1
0
14
Wonderful Tweet sir
➡️ Treatment gap for alcohol use disorders is more than 85%
Please advise your close ones to seek help if they are having alcohol use disorder
➡️ There are evidence based treatments available for quitting alcohol
Seek help
Today, few neighbors of my patient, a 33 year old man, came into my outpatient department to convey the message that he had died by suicide.
On the way to Kasargod town by train, he jumped on to the tracks from the moving train and was smashed to death.
He was sufferring from
240
1K
4K
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We (AIIMS Deoghar)
@deoghar_aiims
and
@aiimsrishi
have Psychiatry as a separate paper in the final year!
First batch will be taking exam in Jan 2023!
Some students write and give answers like a 2nd year JR😊 in psychiatry (internal)
Hopeful this wl have an impact😊
@doc_santanu
1
0
12
An epidemic during pandemic: increase in delirium tremens (complicated alcohol withdrawals) following lockdown.
@lekhanshshukla
@jayanishere
@JayantMahadevan
@prabhatVKN
@DiptadhiM
@drroshansindia
@atulambekar
@netshrink
@AnantBhan
@ISAMAddiction
2
6
11
World mental health day PGI 5km run!
#preventsuicide
. Back to back 2 runs this week. NIMHANS run on October 2. PGI run on October 6.
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These are treatment seeking populations
At a community level things are a bit different
0
2
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0
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Thank you sir for the kind words 🙏
You have always been an inspiration to many juniors like me 😊
Your blessings means a lot🙏
@manosuraksha_fd
@gsuhasg
డా నరసింహ, నాకు బాగా సుపరిచితుడు. మంచి వైద్యుడు. మానసిక వైద్యంలో ఎండీ, డీఎం, పోస్ట్ డాక్టరల్ ఫెలో మొదలైన చదువులన్నీ చదివి, ప్రఖ్యాత ఎయిమ్స్ లో పాఠాలు చెప్పి, ఇప్పుడు తన సొంత ప్రైవేటు ప్రాక్టీసు బెంగళూరులో ప్రారంభించారు.
డా నరసింహ నాకు రెండేళ్ల జూనియర్. ఓర్పు తో పాటు వైద్యంలో
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#Alcohol
#IntimatePartnerViolence
(IPV)
🔸Compared to women whose husbands never drank, those with husbands who drank had significantly ⏫ odds of experiencing
#physical
,
#emotional
, &
#sexual
violence
🔸For all the types of IPV, an increase in empowerment was associated...
1/2
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2
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#Cycling
#AIIMSDeoghar
A beautiful
#offroad
#countryside
cycling 🚴♀️ track
#11km
from
@deoghar_aiims
#NatureBeautiful
#FitnessGoals
0
0
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#Agitation
Management of acute
#Agitation
in patients with
#Schizophrenia
#Bipolar
&
#Delirium
Tremens is a challenge for clinicians
A molecule commonly used by
#anasethesists
(incl. my
#wife
) was found effective in a couple of RCTs
#Dexmedetomidine
Sublingual
1/👇
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